The Balloon Paradox - A Case Series

Abstract

Background: Once regarded as the final frontier of coronary intervention, the success rates of chronic total occlusion (CTO) angioplasties have been steadily increasing. Understandably, the use of specialized hardware makes this an expensive undertaking. We propose a novel, creative, and inexpensive method to address this issue, by simply using a balloon, differently. Case summary: While specialized wires facilitate crossing the CTO segment, lesion preparation remains a challenge. Vigorous manipulation of routine PCI balloons for lesion entry can be detrimental. Tapered micro-catheters are successful as they rely on rotational forces and maintain guide stability. Newer CTO PCI balloons have crossing profiles comparable to most micro-catheters. Hence, applying rotational force on these kink-resistant balloons, facilitates their use as low-cost micro-catheters. We employed this technique, with surprisingly good results. While not all the lesions could be successfully crossed, the financial implications of this study on a small cohort of patients are, in our humble opinion, quite significant. Discussion: The aforementioned method uses inexpensive hardware, which can be used further, for lesion preparation. The balloon functions on the principle of a Tornus catheter, burrowing deep into the occluded segment. While this technique has higher failure rates in heavily calcified lesions, we were able to cross the lesion in a fair number of cases. We believe this technique, which is safe and simple, can reduce the dependence on complicated and expensive CTO hardware in a significant number of cases. Learning Points 1. Balloon can be used like a corsair and tornus in balloon uncrossable lesions 2. It provides a safe and inexpensive way to cross such lesions.